Clinical News

Regional Commissioning Workshops

Monday, 21 March 2016 11:52

Your clinical team are invited to meet your commissioners at a regional interactive half-day workshop:

Achieve a Winning Business Case to Improve Outcomes in Gastroenterology & Hepatology Services – An Action Plan

BIRMINGHAM Friday 6th May 8.30am-12.40pm Chair Dr Rupert Ransford
At University of Birmingham, Hornton Grange, 53 Edgbaston Park Rd, Edgbaston B15 2RS (free onsite parking)

MANCHESTER Wednesday 18th May 8.30am-12.40pm Chair: Dr Yeng Ang
Venue TBC

LONDON Friday 20th May 9am-1.15pm Chair: Dr A Frank Muller At Broadway House, Tothill Street London SW1H 9NQ

EAST OF ENGLAND Thursday 12th May 5.30pm-8.10pm Chair Dr Andrew Douds
At Bedford Lodge, Bury Road, Newmarket, CB8 7BX

The BSG has arranged a series of interactive, multi-disciplinary half day workshops for you to help address the challenges many of us are facing in developing our Gastroenterology and Hepatology services. Successful developments seem to occur when Clinicians and the wider Clinical Team work with local Commissioners to agree plans and how they can be funded. Please find the programme and registration form above. The BSG has fully supported this workshop as it is considered to be very important in enabling the developments that we all need to improve the standard of care of our patients.

The objectives are to understand your commissioners' priorities, new NHS developments, identify your service challenges, how to redesign you care pathways and begin to develop a winning business case and action plan with your Commissioners and patients.


To ensure the workshops are truly helpful for you we are asking you to bring along your Clinical Teams (e.g. clinical and nurse leads, hospital business and service managers) and invite your local CCG and Specialised Commissioners so you can discuss the challenges, priorities and actions to redesign your services.

Please find attached a suggested template email for you to invite your local commissioners to join you at this half day workshop. You will also need to attach the workshop programme.


The series of workshops will culminate with a National Action Plan recommending the key actions for you and your commissioners to improve your services. This will be launched at the BSG Annual Conference on 23rd June 2016 and copies will be sent FREE to all delegates.

We do hope you will be able to join us at this important meeting; please complete the registration form at the end of the programme and return it FREEPOST to Medical Management Services (UK) Ltd, the workshop organisers or simply register at

We would also like to thank both Norgine Ltd and Takeda Ltd whose funding have made these meetings possible.

BSG Guidance on the Use of Biosimilar Infliximab CT-P13 in IBD

February 2016

Introduction: Dr AB Hawthorne, Chair BSG IBD Section Committee

The infliximab biosimilar CT-P13 (Remsima or Inflectra) received marketing authorisation in June 2013.The drug is now widely used in the treatment of inflammatory bowel disease. There is sufficient data from observational studies to show that safety and clinical efficacy of CT-P13 are comparable to the originator drug, with similar immunogenicity.


  1. Infliximab must be prescribed by brand name (ie Remicade, Remsima or Inflectra) and not by International Non-proprietary Name (INN).
  2. For patients starting infliximab: Remicade, Remsima or Inflectra can be prescribed, taking into account the evidence showing similar clinical effectiveness. There is evidence that monitoring of patients, including measurement of drug and anti-drug antibody levels, is no different for the biosimilar drugs compared to Remicade. The choice of preparation should take into account the cost of the drug and its administration.
  3. There is sufficient evidence to recommend that patients who are in a stable clinical response or remission on Remicade therapy can be switched to Remsima or Inflectra at the same dose and dose interval. This should be done after discussion with individual patients, with explanation of the reason for switching (which is usually on the grounds of benefit to the overall service by reduction in costs of the drug and its administration).
  4. Automatic substitution, (dispensing one medicine instead of another equivalent and interchangeable medicine at the pharmacy level without consulting the prescriber), is not appropriate.
  5. Pharmacovigilance is essential for any new biological medicine, and patients prescribed Remsima or Inflectra should be followed for safety, in a registry such as the UK National IBD Registry.

This document replaces the previous BSG guidance on Biosimilar drugs - IBD Section Statement on Biosimilar drugs (2014) (View here)

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants

Monday, 15 February 2016 10:45

New BSG/ESGE guideline...

The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy.

P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation). For highrisk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation).

Warfarin The advice for warfarin is fundamentally unchanged from British Society of Gastroenterology (BSG) 2008 guidance.

Direct Oral Anticoagulants (DOAC) For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation); For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥48 h before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30–50 mL/min we recommend that the last dose of DOAC be taken 72 h before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation).

NICE Quality Standard: Irritable bowel syndrome in adults

Monday, 15 February 2016 13:50

This quality standard covers the diagnosis and management of irritable bowel syndrome in adults. It does not cover other gastrointestinal disorders such as non-ulcer dyspepsia, coeliac disease and inflammatory bowel disease. For more information see the irritable bowel syndrome topic overview.

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